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Here’s an eye opener! Look better and see better with surgery for ptosis.

by Gupta, Manish

You may remember to old cartoon character Droopy Dog. In the first scene of the 1943 debut, Droopy saunters in, looks at the audience and says “Hello all you happy people. You know what? I’m the hero.” Droopy’s meek, deadpan personality and appearance made him an improbable looking hero. Still, he managed to consistently foil his adversaries. There are a lot of people, especially Baby Boomers, who feel that their appearance does not adequately reflect how youthful, vigorous, and “heroic” they really feel despite the fact that, like Droopy, they have rather sad, drooping basset hound eyes.

Those droopy eyes might be natural for a basset but in humans the comparable condition is called ptosis (pronounced TOE-sis). That’s the medical term for drooping eyelids that can make you look older and interfere with peripheral vision, compromising sight by up to 30%. Ptosis may be present at birth when the levator muscle that controls the eyelid fails to develop properly. Like lazy eye, the condition can permanently damage vision, if untreated, by causing the unaffected eye to do all the work while the affected eye degenerates. Children with congenital ptosis often try to compensate by tilting their heads back or raising their eyebrows in an effort to lift the eyelid. An acquired form of ptosis is usually associated with aging. It is called levator dehiscence because it results when the levator muscle that controls the eyelid stretches or detaches completely.

Plastic surgeon Manish R. Gupta, MD, says that a simple but delicate procedure called blepharoplasty removes excess skin, muscle, and fat from the eyelid and may also involve tightening or reattaching the levator muscle. Blepharoplasty can correct the problems associated with ptosis, leaving the patient not only seeing better but looking better as well. He recalls one patient who had tried to compensate for his ptosis by lifting his eyebrows. The constant effort produced headaches, another medical consequence associated with what might appear to be merely a cosmetic problem.

“A 67-year-old grandmother came to see me about an unrelated matter,” says Dr. Gupta. “While she was here, she asked if there was anything that could be done for droopy eyelids that covered a third to half of her field of vision. I sent her to an ophthalmologist to confirm that she had no underlying eye disease or problem that might need to be addressed first.”

Dr. Gupta says blepharoplasty is a relatively straightforward but delicate procedure. “Every eyelid has natural wrinkles and creases that make it possible for the surgeon to make an incision in a place where there will be no visible scar,” he says. “The procedure is done under local anesthesia and normally takes about an hour and a half. I use very fine 6/0 sutures that are virtually invisible without magnification. It is important not to leave visible scars and not to remove too much skin. If you can’t close your eyelid completely, it leads to dry eye and possibly to a dry, scratched cornea. This patient, as is typical, had puffy black eyes for a couple of weeks but by four weeks after surgery there were no residual signs—except, of course, that she looks and sees a lot better. Now she also feels safer driving her grandchildren because of the improvement in her peripheral vision. She says she had not realized how much her vision had been limited because the deterioration had been gradual and, as she grew accustomed to it over time, the limited vision seemed normal to her.”

Because ptosis does interfere with vision, Medicare and insurance companies usually approve payment for the surgery even though there is a very definite cosmetic benefit as well. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or brow lift.
Another of Dr. Gupta’s patients, a retired engineer, was brought in by his wife. “He said that his drooping eyelid didn’t bother him but she said that didn’t matter because it bothered her! I performed a very simple, non-invasive test to measure how well the levator muscle was working then I sent him to his ophthalmologist before the surgery to make sure there were no underlying problems that might be masked by the drooping lid. One of the reasons I perform blepharoplasty under local anesthesia is so that I can check the movement of the eyelid in comparison to the other lid and that requires the cooperation of the patient. Following the surgery, he sees better and his wife is happy because he looks a lot better. He says his friends have told him that he looks less tired and more alert.”

Lower lids as well as drooping upper eyelids can benefit from blepharoplasty. One of Dr. Gupta’s patients is a burn victim. “Scars pulled down his lower lid so his eye was at risk for corneal scratches. I released the scar and performed a mini-facelift to give support to the eyelid. This was an extremely difficult problem because of the damage associated with his burns and the eyelid was just part of a much larger issue. The key was to protect his eye because function is more important than appearance.”

If you are concerned that ptosis may be interfering with your vision or with the youthful appearance you would prefer, contact Dr. Gupta’s office at 419-362-5221.